The Council for Medical Schemes
There are close to 100 medical aids in South Africa and nearly 8 500 000 beneficiaries with an annual contribution of more than R84 billion. So this huge industry needs a watchdog and the Council for Medical Schemes plays the role.
Significantly, the Council is a statutory body. Since 1998 it has regulated the country’s private medical aid industry.
It also guarantees that beneficiaries receive fair treatment and have access to the benefits stipulated in the rules of their individual health insurance scheme or hospital plan.
The Minister of Health appoints a board that consists of 15 members, including a non-executive chairman and a deputy chairman, who serve on a part-time basis, for a maximum of three years.
This board is referred to as the Council and its members meet on at least four occasions annually. Members are chosen from diverse backgrounds and they represent a cross section of skills that range from law to consumer affairs. They are responsible for the overall policy of the Council for Medical Schemes.
An executive committee conducts the daily decision-making and supervision of staff and it holds monthly meetings. They are also responsible for informing the general public, stakeholders and media organisations of the work of the Council.
This management team consists of executive managers and the Chief Executive who is referred to as the Registrar. The Registrar is also elected by the Health Minister.
The role of the Council for Medical Schemes:
- Safeguards the interests of medical aids and their members
- Monitors the solvency and financial status of these medical institutions
- Investigates complaints and finds resolutions to disputes
- Collects and circulates data about South Africa’s private health care sector, including health insurance costs
- Ensures that various private medical aids comply with national health policies
- Creates rules and guidelines, in accordance with the Medical Schemes Act, about the Council’s own purpose and authority
- Makes recommendations to the Health Minister about the services provided by the country’s medical aid companies
- Informs the general public about their rights to ensure they receive the best health insurance they can afford
A primary role of the Council is to assist any person who is unhappy with the actions of a medical aid. So if one belongs to a medical aid, their first course of action is to contact and lodge a complaint with that particular scheme.
Should there be no resolution or the complainant is unsatisfied with the result, then they can contact the Council for Medical Schemes. Then the Complaints Unit will investigate their grievance without requesting any fees.
If this person is not satisfied with the decision made by the Registrar then they can lodge a plea with the Appeal Board. This step requires payment of a fee.
A person who has a complaint about their health cover insurance or the medical aid industry can submit their objections through a written letter, by sending a fax or e-mail or visiting the CMS in person.
Customer Care Service Centre: 0861 123 267
Reception Telephone: (012) 431 0500
Fax: (012) 430 7644
Email Enquiries: firstname.lastname@example.org
Fax: (012) 431-0608
The complaints procedure can be found on the Council for Medical Schemes website.
Private Bag X34
Hadfields Office Park, Block E
1267 Pretorius Street
Latitude : S 25 44 40.0992
Longitude : E 28 14 37.3344
All info was correct at time of publishing